I've said this before, but I'm going to say it again: The time to designate your personal Health Advocate is while you are healthy. If you wait until you are hospitalized, in pain, and under the influence of narcotics, you might not even realize you need an advocate. Or, if you do realize it, may be unable to articulate it. Worse, if you are unable to communicate at all, a health advocate will be determined by fate alone (it'll be your closest kin).
Your Health Advocate must possess three things:
First, intelligence. The HA doesn't need to be a genius or hold a medical degree, but must understand how to perform quick research on your behalf, and how to utilize that research. The HA doesn't need to know right now what BUN levels measure, but must know where to find that information. Critical thinking skills are a must. This person will be taking in rapidly-changing information from a variety of sources, then either advising your next-of-kin about, or making on their own, decisions that may well determine the course of your life from that point forward.
Second, confidence. The hospital setting can be confusing, overwhelming, and intimidating--and the level of confusion and intimidation rises with the severity of the situation. Your Health Advocate needs to be confident enough to ask questions of people who may not want to be questioned, to double check every piece of information, and to point out potential problems and inconsistencies. He needs to be able to do so in the face of extreme displeasure from those being questioned, to walk up to and/or follow medical professionals who want to move on before answering your questions, and ask for second opinions.
Third, emotional control. The HA can't be the one who gets flustered, who cries easily, or angers quickly. An even keel is best. If the HA has great confidence to ask questions, but can't keep a lid on frustration or fear, the likely result is a deeply pissed off and offended medical professional. Civility must be maintained. The HA should be able to ask nursing staff for what you need, and remember to smile and say thank you when it's delivered. Along the same lines, the HA should be the one you can count on to give you a sense of control amidst frightening situations. Keeping your stress levels low is equally important as making sure you get the right medications.
If your next of kin doesn't display those traits now, do not hope he or she will rise to the occasion in a crisis. That's not fair to either one of you. Let your next of kin be precisely who he or she is. Let your HA take the other burden. In my family situation, we all know my father wouldn't make a good HA for my mother. He knows this. So our family agreement is that his job would be as my mother's emotional anchor. My sister and I would be the HA.
Research has varied over the years, but placing U.S. deaths from medical errors around 100,000 annually seems to be the general agreement. About 1.5 million folks suffer "adverse events" from medication errors. Your HA is there to reduce the likelihood you'll end up in those statistic pools.
First example: Over a decade ago, my mother took a nasty fall and broke her ankle. The damage was severe enough to require extensive surgery and lots of screws to hold the bones in place. The day after her surgery, I arrived at the hospital to find her in so much pain, she was soaked in sweat and having trouble breathing. I got a nurse who came in for about twenty seconds, and informed me my mother had maxxed out the morphine pump, and couldn't be given additional pain medication.
I found another nurse who took one look at my mother, and knew there was no way she'd be in such physical distress under a max dose of morphine. A quick check revealed the morphine pump was malfunctioning, and hadn't delivered a single dose for hours. That incident made the need for an advocate clear to me.
Second example: Right before my late husband was formally diagnosed with liver cancer, he was hospitalized for a heart attack triggered by uncontrolled internal bleeding. Lab tests showed his blood wasn't clotting properly (as happens when the liver isn't producing clotting factors), and his liver and kidneys were performing really, really poorly. So the Liver Doctor ordered a bunch of tests and some vitamins to bolster the blood until he knew what else was going on. The Heart Doctor looked over the chart, saw 'heart attack,' and prescribed aspirin and statins.
Yeah. Aspirin to thin the blood and statins to further impair liver function. Had someone not checked the med list, he may have had those medications for a week before Liver Doctor found out. That alone could have killed him. Liver Doctor was livid; Heart Doctor never crossed our path again.
The first example happened in a hospital considered one of the state's best. The second happened in the VA hospital. I point that out to make clear the facility you expect to be treated within shouldn't make a difference on whether you designate an advocate.
So now is the time. Talk the person (or persons) you'd trust with your life. Complete a HIPPA Authorization Form that will allow that person access to medical records for situations you determine. Consider if you also need to complete a medical power of attorney. It doesn't take much time or effort.
It is totally worth it.
(This Public Service Announcement triggered by the recent hospitalization of a family member who nearly lost his colon because no one was present to effectively advocate for him.)